The effect of thiol disulfide levels on diagnostic and therapeutic processes in the management of ischemic stroke in the emergency department

Introduction And Aim: In this study, it was aimed to reveal whether thioldisulfide homeostasis can be used in the early diagnostic approach in ischemic stroke and whether it would affect the treatment processes. Materials and Methods: This prospective and clinical study was conducted in Sakarya University Training and Research Hospital Emergency Medicine Clinic between October 1st 2019 and March 1st 2021, including a total of 120 patients. The patients including in the study were divided into three groups. 1st Group: Patients admitted to the Emergency Department within the first 4,5 hours after the first stroke symptoms presentation. 2nd Group: Patients admitted to the Emergency Department after the first 4,5 hours of stroke symptoms presentation. 3rd Group: Wake up strokes. Residual blood from routinely collected blood from patients was used for parameters of thioldisulfide homeostasis. Blood samples were stored at -80°C until the day they would be tested in the laboratory. In blood samples: disulfide, natural and total thiol levels were measured. Disulfide/thiol ratios were recorded and analyzed in the SPSS program, and those with a p volue of<0,05 were considered significant. Results: It was determined that the mean age of the patients included in our study was 69,87±12,61 and 60 of them (50%) were male. It was determined that 38 of the patients applied to the Emergency Department within 4,5 hours from the onset of stroke symptoms, 63 of them applied more than 4,5 hours later and 19 of them were noticed by their relatives after waking up and admitted the Emergency room. It was determined that there was no statistical difference between the groups in terms of Native Thiol, Total Thiol, Thiol Disulfide, Disulfide/Nativ Thiol Percentage, Disulfide/ Total Thiol Percentage and Thiol/Total Thiol Percentage (respectively; p=0,343, p=0,449, p=0,529, p=0,1, p=0,099, p=0,099). It was determined that the ratio of Native Thiol and Native Thiol /Total Thiol was higher in patients who received medical treatment, and this level was considered statistically significant (respectively; p=0,027, p=0,001). Disulfide/Native Thiol and Disulfide/Total Thiol rations were found to be lower in patients who receivedmedical treatment, and this decrease was considered statistically significant (respectively; p=0,001, p=0,001). Conclusion: It ise shown that no clinic decision can be made about the duration of stroke (waking up, acute and delayed) according to the Thiol levels in patients admitted to the emergency department due to ischemşc stroke. It was determined that the ratio of Native Thiol and Native Thiol/Total Thiol was higher in patients who received medical treatmenti and the ratios of Disulfide/Total Thiol were lower. Although this data contributes greatly to the literature in its current form, it needs to be supported by further additional studies. Keywords: Stroke, İschemich Stroke, Thiol homeostasis, Emergency Medicine